The Old Vicarage

Updated 18 March 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This was a focused inspection to review the Key Questions of Safe and Well-led only. Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. They supported the inspection by seeking feedback from relatives over the telephone.

Service and service type

The Old Vicarage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The service had two managers, who were both in the process of registering with CQC at the time of inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority about the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with three people who used the service and six relatives. We spoke with six staff. We spoke with one of the managers, the director of operations, area operations manager and quality and operations manager. We looked at a range of records including five people’s care records and how medicines were managed for people. We also looked at staff training, and the provider’s quality auditing system. During the inspection visit we asked provider to give us additional evidence about how the service was managed, which they did. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We spoke with staff and relatives after the inspection visit to get feedback from them about the quality of the service. We continued to seek clarification from the provider to validate evidence found and reviewed the evidence they sent us.

Updated 18 March 2021

About the service

The Old Vicarage is a residential care home which provides accommodation and personal care for young adults whom are living with a learning disability and/or autism. At the time of our inspection 13 people were living there. The service can support up to 14 people. The service is split into two units known as ‘The Old Vicarage’ and ‘The New Vicarage’.

The Old Vicarage consists of four bedrooms in the main house and three apartments on the first floor. The New Vicarage consists of five apartments and a two-bedroom cottage. Each apartment is self-contained with bedrooms, bathroom facilities and living space. Each area has their own entrances with dedicated staff teams, communal space, garden space and separate offices for managers.

People’s experience of using this service and what we found

People were not always kept safe from the risk of abuse. There were times when people had been left without the support they needed, placing them at risk of harm. Most relatives felt their family members received safe care and support generally. However, some relatives expressed concerns about the frequent changes of management which led to inconsistencies in how risks to people were managed. There were enough staff, but at times, they had not always been deployed effectively. The provider had taken action to ensure people were not left without the support they needed.

People did not consistently receive their prescribed medicines safely. Accidents and incidents were not consistently monitored to identify trends and to prevent reoccurrences. This meant that the opportunity to learn lessons and reduce the risk of future incidents did not always happen.

The service was not consistently well-led. Frequent changes in managers since the last inspection in 2019 had resulted in a lack of robust oversight of the quality of care. The provider worked with the local authority to investigate any incidents or accidents. However, lessons learnt from investigations were not consistently acted on to improve care for people.

Staff understood how to recognise and report concerns or abuse. Risks associated with the service environment were assessed and mitigated. There were clear plans in place to guide staff in what to do in an emergency, and staff knew what the plans were. Relatives and staff felt there were enough staff available to meet people’s needs and provide 1-1 support when this was needed.

The service was clean and staff knew how to reduce the risk of acquired infections. We saw some staff did not always wear their personal protective equipment (PPE) correctly. The provider addressed this on the day of our inspection.

The provider had recently appointed two new managers at the service, and relatives and staff told us about the positive impact this had.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. This was due to the number of avoidable incidents that happened at the service, leading to people being put at risk. The provider was working to address the concerns we found to ensure people felt safe and care was person-centred.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published on 14 May 2019).

Why we inspected

We received concerns in relation to unsafe staffing levels and medicines management. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. The provider has already started work on improving the quality of care in response to the concerns we found. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Vicarage on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.